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A small rural hospital in Pennsylvania is trying a new strategy to keep its doors open -- running a .

Bucktail Medical Center (BMC) in Renovo, Pennsylvania, is trying to raise $1.5 million after two "catastrophic" events put it under severe financial strain.

"If you, as owners of the facility, want the hospital to survive, we need your donation today," the GoFundMe page states. "Despite our best efforts, we simply do not have the cash available to continue providing services."

The 16-bed critical access hospital, which also has a 43-bed nursing home, is the only hospital in Clinton County, .

Hospital CEO Tim Reeves, LNHA, is listed as the campaign organizer, and he told PennLive the campaign was the idea of a hospital board member.

Reeves wrote that the hospital recently learned its final federal employee retention credit payment of $381,941 is "delayed indefinitely," and the state's department of human services wants reimbursement of $255,467 for care delivered in the 2018-2019 fiscal year.

Both of these are catastrophic events for the hospital's finances, Reeves wrote.

The hospital also lost about $150,000 per month for the last year because costs exceeded reimbursements, Reeves told PennLive.

He noted in the campaign that small rural hospitals "are being forced to close because they are not paid enough to cover the cost of delivering care to patients in rural areas."

Reeves, who has been with the facility since 2014, told 麻豆传媒 that the current reimbursement structure is a particular challenge for small facilities like his, which has a patient base of just about 3,100. Rural facilities serving about 15,000 people, on the other hand, "can be viable under the current reimbursement structure, or at least get a lot closer" to viability. But his small facility "doesn't have the volume to offset all the costs" of care, he said.

"If 25 people come to the emergency department, I can pay for the doctor," he said. "But a slow day is 1 or 2 patients, and a busy day is 8, so I'm not covering that expense."

Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform in Pittsburgh, agreed that insufficient reimbursement is a key driver of increasing closures among rural hospitals.

Citing data from his site , Miller said BMC's average 3-year patient services margin was down about 27%, and most of that loss was due to private health insurance plan reimbursement, including Medicare Advantage.

Unlike large hospitals, which make little from Medicare and larger profits off private health insurance plans, Medicare is often the best payer for small hospitals, Miller told 麻豆传媒.

"It's exactly the opposite at rural hospitals," he said, which are reimbursed at cost by Medicare, take a small loss on Medicaid, and a big loss on private insurance.

As more patients switch from traditional Medicare to Medicare Advantage plans, which are run by private insurance companies, rural hospitals in particular feel the strain, he said: "It's a big issue for a lot of rural hospitals around the country."

Medicare Advantage plans now cover about 50% of the Medicare-eligible population nationally, Miller noted. "Rural areas tended to have a lower penetration, but as these plans try to expand, they are increasingly going into rural areas, and taking away one of the best payers that these small hospitals have."

Medicare Advantage plans are more likely to deny claims, and smaller hospitals just don't have the resources to fight back, Miller said.

"What's unfortunate is this community hospital is having to ask the community to donate money to subsidize the health insurance plans that are underpaying the hospital for care," Miller said. "The right solution would be for the health plans to pay them adequately."

Ultimately, it's the people who live in Renovo and the surrounding area who will suffer, he added.

Reeves noted in the campaign that the next closest emergency department is about 29 miles away, which means "37 minutes down a two-lane country road that winds along the west branch of the Susquehanna River."

Since that facility closed all of its inpatient and surgical services in April, the next closest hospital with inpatient services is just over 40 miles away, and "50 minutes down the same road," according to the GoFundMe page.

Reeves also pointed out that BMC currently has the only ambulance service in the area, and without it, patients would have to wait nearly 40 minutes for the next closest ambulance just to get to them.

"Should BMC close, no healthcare services would be available. No ER, no blood tests, no x-rays, no medical appointments, no nursing home, and no ambulance," the campaign states. "Every medical need will require a trip down the road. Lives will be lost."

Currently, the campaign has raised about $10,500. Reeves told PennLive he's optimistic that the hospital will make the next payroll (it's the largest employer in western Clinton County, with 85 employees), and that some vendors who haven't been paid on time have been cooperative.

However, physical and occupational therapy stopped last week when the company that provided the staffing pulled out, PennLive reported.

Reeves said the hospital is actively working on other solutions as well, but noted that even if it receives a quick infusion of cash, that won't solve the problem for the long-term.

"Aside from any potential help we can get," he said, "I think it might be an important tool for discussing rural health and the state of rural hospitals."

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